L03.319 — Cellulitis of trunk, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Photographic documentation demonstrating the panniculus hangs below the level of the pubis.
- Clinical documentation showing difficulty with personal hygiene, ambulation/walking, or other physical activity due to the panniculus.
- Medical records and photographs documenting at least one chronic/persistent complication under the panniculus.
- Evidence of trials and failure of appropriate medical therapy (topical antifungals; topical/systemic corticosteroids; local/systemic antibiotics) for ≥3 months.
Key Coverage Criteria
- Panniculus hangs below the level of the pubis, documented by photographs.
- Non-healing ulceration under the panniculus persisting despite ≥3 months of appropriate therapy.
- Chronic maceration or necrosis of overhanging skin folds persisting despite ≥3 months of appropriate therapy.
- Recurrent or persistent skin infection under the panniculus despite ≥3 months of appropriate therapy.
- Intertriginous dermatitis, cellulitis, or panniculitis under the panniculus persisting despite ≥3 months of appropriate therapy.
- Panniculus that limits physical activity or activities of daily living (ADLs).
1 Active Policy
AMBETTER-CP.MP.109 — Panniculectomy
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.